title: Severe metformin intoxication treated with prolonged haemodialyses and plasma exchange.
abstract: BACKGROUND
  Biguanides pose a significant risk of morbidity, mortality and permanent sequelae secondary to prolonged periods of hypoglycaemia.
  
  
  OBJECTIVE
  To investigate the treatment of massive metformin overdose associated with lactic acidosis.
  
  
  METHODS
  We present the case of a 30-year-old woman, who attempted to commit suicide by ingesting an 85-g massive metformin overdose associated with severe lactic acidosis, which we treated by performing prolonged haemodialysis with bicarbonate and plasma exchange.
  
  
  CONCLUSIONS
  For the maximum elimination of metformin, extended haemodialysis is required and the treatment of the accompanying metabolic acidosis with bicarbonate is important for the effectiveness of the treatment. Patients benefit much more from the treatment of combined haemodialysis with plasma exchange.
authors.affiliation: Department of Emergency Medicine, Pamukkale University, Denizli, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Turkcuer
authors.forename: Bulent
authors.initials: B
authors.lastname: Erdur
authors.forename: Ismail
authors.initials: I
authors.lastname: Sari
authors.forename: Aykut
authors.initials: A
authors.lastname: Yuksel
authors.forename: Pinar
authors.initials: P
authors.lastname: Tura
authors.forename: Sinemis
authors.initials: S
authors.lastname: Yuksel
mesh_terms: D000140:Acidosis, Lactic / Q000209:etiology / Q000628:therapy*; D000328:Adult; D062787:Drug Overdose / Q000628:therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000506:poisoning*; D008687:Metformin / Q000506:poisoning*; D010951:Plasma Exchange; D006435:Renal Dialysis; D013406:Suicide, Attempted
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin